A diagnostic system for sleep apnea based on oxygen saturation and RR intervals obtained from the EKG (electrocardiogram) is proposed with the goal to detect and quantify minute long segments of sleep with breathing pauses. We measured the discriminative capacity of combinations of features obtained from RR series and oximetry to evaluate improvements of the performance compared to oximetry-based features alone. Time and frequency domain variables derived from oxygen saturation (SpO2) as well as linear and non-linear variables describing the RR series have been explored in recordings from 70 patients with suspected sleep apnea. We applied forward feature selection in order to select a minimal set of variables that are able to locate patterns indicating respiratory pauses. Linear discriminant analysis (LDA) was used to classify the presence of apnea during specific segments. The system will finally provide a global score indicating the presence of clinically significant apnea integrating the segment based apnea detection. LDA results in an accuracy of 87%; sensitivity of 76% and specificity of 91% (AUC = 0.90) with a global classification of 97% when only oxygen saturation is used. In case of additionally including features from the RR series; the system performance improves to an accuracy of 87%; sensitivity of 73% and specificity of 92% (AUC = 0.92), with a global classification rate of 100%.

In this paper the permutation entropy (PE) obtained from heart rate variability (HRV) is analyzed in a statistical model. In this model we also integrate other feature extraction techniques, the cepstrum coefficients derived from the same HRV and a set of band powers obtained from the electrocardiogram derived respiratory (EDR) signal. The aim of the model is detecting obstructive sleep apnea (OSA) events. For this purpose, we apply two statistical classification methods: Logistic Regression (LR) and Quadratic Discriminant Analysis (QDA). For testing the models we use seventy ECG recordings from the Physionet database which are divided into equal-size learning and testing sets. Both sets consist of 35 recordings, each containing a single ECG signal. In our experiments we have found that the features extracted from the EDR signal present a sensitivity of 65.6% and specificity of 87.7% (auc = 85) in the LR classifier, and sensitivity of 59.4% and specificity of 90.3% (auc = 83.9) in the QDA classifier. The HRV-based cepstrum coefficients present a sensitivity of 63.8% and specificity of 89.2% (auc = 86) in the LR classifier, and sensitivity of 67.2% and specificity of 86.8% (auc = 86.9) in the QDA. Subsequent tests show that the contribution of the permutation entropy increases the performance of the classifiers, implying that the complexity of RR interval time series play an important role in the breathing pauses detection. Particularly, when all features are jointly used, the quantification task reaches a sensitivity of 71.9% and specificity of 92.1% (auc = 90.3) for LR. Similarly, for QDA the sensitivity is 75.1% and the specificity is 90.5% (auc = 91.7).

Permutation entropy obtained from heart rate variability (HRV) is analyzed in a statistical model integrating electrocardiogram derived respiratory (EDR) features and cepstrum coefficients in order to detect obstructive sleep apnea (OSA) events. 70 ECG recordings from Physionet database are divided into a learning set and a test set of equal size. Each set consists of 35 recordings, containing a single ECG signal. Each recording includes a set of reference annotations, one for each minute, which indicates the presence or absence of apnea during that minute. Statistical classification methods based on Logistic Regression (LR) is applied to the classification of sleep apnea epochs. EDR presents a sensitivity of 64.3% and specificity of 86.5% (auc=83.9). Cepstrum presents a sensitivity of 63.8% and specificity of 89.2% (auc=86). Contribution of the permutation entropy increases the performance of the LR model, playing an important role in the OSA quantification task. In particular, when all features are analyzed, classifier reaches a sensitivity of 70.2% and specificity of 91.8% (auc=89.8).

In this paper, we thoroughly analyze the detection of sleep apnea events in the context of Obstructive Sleep Apnea (OSA), which is considered a public health problem because of its high prevalence and serious health implications. We especially evaluate patients who do not always show desaturations during apneic episodes (non-desaturating patients). For this purpose, we use a database (HuGCDN2014-OXI) that includes desaturating and non-desaturating patients, and we use the widely used Physionet Apnea Dataset for a meaningful comparison with prior work. Our system combines features extracted from the Heart-Rate Variability (HRV) and SpO₂, and it explores their potential to characterize desaturating and non-desaturating events. The HRV-based features include spectral, cepstral, and nonlinear information (Detrended Fluctuation Analysis (DFA) and Recurrence Quantification Analysis (RQA)). SpO₂-based features include temporal (variance) and spectral information. The features feed a Linear Discriminant Analysis (LDA) classifier. The goal is to evaluate the effect of using these features either individually or in combination, especially in non-desaturating patients. The main results for the detection of apneic events are: (a) Physionet success rate of 96.19%, sensitivity of 95.74% and specificity of 95.25% (Area Under Curve (AUC): 0.99); (b) HuGCDN2014-OXI of 87.32%, 83.81% and 88.55% (AUC: 0.934), respectively. The best results for the global diagnosis of OSA patients (HuGCDN2014-OXI) are: success rate of 95.74%, sensitivity of 100%, and specificity of 89.47%. We conclude that combining both features is the most accurate option, especially when there are non-desaturating patterns among the recordings under study.